腹腔镜胆总管探查术联合腹腔镜胆囊切除术治疗老年胆囊结石合并胆总管结石的效果观察

Efficacy of laparoscopic common bile duct exploration combined with laparoscopic cholecystec tomy in the treatment of gallstones complicated by common bile duct stones in the elderly patients

目的探讨腹腔镜胆总管探查术(LCBDE)联合腹腔镜胆囊切除术(LC)治疗老年胆囊结石合并胆总管结石(CBDS)的临床效果。方法回顾性分析2021年3月至2023年3月信阳市中医院收治的86例胆囊结石合并胆总管结石老年患者的临床资料,按照治疗方法将其分为观察组(38例,予以LC联合LCBDE治疗)和对照组(48例,予以LC联合ERCP治疗)。比较两组术中及术后相关指标、手术前后免疫因子水平、手术前后疼痛应激指标及炎症因子水平。结果观察组手术时间、术后排气时间、术后住院时间短于对照组(P<0.05),术中出血量低于对照组(P<0.05);两组净石率与二次治疗率比较差异未见统计学意义(P>0.05)。术前,两组免疫因子水平比较差异未见统计学意义(P>0.05);术后,两组CD4^(+)T、CD8^(+)T、CD4^(+)T/CD8^(+)T低于术前(P<0.05),但两组比较差异未见统计学意义(P>0.05)。术后,两组5-羟色胺、前列腺素E2,白细胞介素-6、肿瘤坏死因子-α水平高于术前(P<0.05),但观察组低于对照组(P<0.05)。结论LCBDE联合LC治疗老年胆囊结石合并CBDS,可有效优化术中及术后相关指标,且免疫功能损伤较小,炎症因子与疼痛应激指标变化较小,患者术后恢复时间短。

Objective To investigate the clinical efficacy of laparoscopic common bile duct exploration(LCBDE)combined with laparoscopic cholecystectomy(LC)in the treatment of gallstones complicated by common bile duct stones(CBDS)in the elderly patients.Methods The clinical data of 86 elderly patients with gallstones complicated by CBDS admitted to Xinyang Hospital of Traditional Chinese Medicine from March 2021 to March 2023 were selected for retrospective analysis.According to the treatment method,they were divided into an observation group(38 cases,treated by LC combined with LCBDE)and a control group(48 cases,treated by LC combined with endoscopic retrograde cholangio-pancreatography).The intraoperative and postoperative surgery related indexes of the two groups were compared.The preoperative and postoperative levels of immune factors,pain stress indicators and inflammatory factors were compared between the two groups.Results The operation time,postoperative exhaust time and postoperative hospital stay in the observation group were shorter than those in the control group(P<0.05);the intraoperative blood loss in the observation group was lower than that in the control group(P<0.05).There was no significant difference in stone free rate and second treatment rate between the two groups(P>0.05).There was no significant difference in the levels of immune factors between the two groups before operation(P>0.05).After operation,the levels of cluster of differentiation 4^(+)T cells,cluster of differentiation 8^(+)T cells,cluster of differentiation 4^(+)T cells/cluster of differentiation 8^(+)T cells in the two groups were lower than those before operation(P<0.05);but there was no significant difference in the above indicators between the two groups after operation(P>0.05).After operation,the levels of 5-hydroxytryptamine,prostaglandin E2,interleukin-6 and tumor necrosis factor-αin the two groups increased compared with preoperative levels(P<0.05),but the above indicators in the observation group were lower than those in the control group(P<0.05).Conclusions LCBDE combined with LC for gallstones complicated by CBDS in elderly patients can effectively optimize intraoperative and postoperative related indicators.This protocol has less damage on immune function and less changes in levels of inflammatory factors and pain stress indicators,and requires shorter postoperative recovery time.